People who actually completed a home stool test when invited to colorectal cancer screening had a 43 percent lower risk of dying from the disease, according to a new analysis of Sweden's Stockholm-Gotland program. The findings, published August 20, 2026, in JAMA Network Open, come from up to 14 years of follow-up on 376,511 participants.
The study was led by researchers at Karolinska Institutet and Umeå University, who tracked 1,668 deaths from colorectal cancer during the follow-up period. Even simply receiving the screening invitation, regardless of whether people took the test, was linked to a 26 percent lower risk of dying from the disease.
Why the participation gap matters
The Stockholm-Gotland program, which began routine screening in 2008, mails home testing kits that check stool samples for occult blood. Positive results lead to a colonoscopy. Yet about one in three invited individuals do not send back a sample.
"Although screening is offered free of charge and the test is simple to carry out, around a third of people do not submit a sample," Johannes Blom, senior consultant and associate professor at Karolinska Institutet, said in a statement from the university.
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He added that the new numbers reinforce the case for showing up. "Our study highlights the importance of taking part in colorectal cancer screening, and shows that it can actually save lives."
The 43 percent estimate is based on statistical adjustments for contamination bias and nonadherence, meaning the researchers accounted for people in the control arm who got screened elsewhere and for people invited who never participated. Because this is an observational study, some uncertainty remains, but the size of the effect and the length of the follow-up strengthen the signal.
What this means for adults in the US
Colorectal cancer is expected to cause about 55,230 deaths in the United States in 2026 and remains the second most common cause of cancer deaths when men and women are counted together, according to the American Cancer Society. The society projects roughly 108,860 new cases of colon cancer and 49,990 new cases of rectal cancer this year.
The US Preventive Services Task Force recommends screening for all adults aged 45 to 75, a range that was lowered from 50 in 2021 to reflect rising cases in younger adults. For people between 76 and 85, the task force advises selective screening based on health status, prior screening history and personal preference.
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Options approved by the task force include an annual fecal immunochemical test (FIT), a stool DNA test every one to three years, flexible sigmoidoscopy, CT colonography and a colonoscopy every 10 years. None of these tests works if it sits in a drawer, which is the practical lesson from the Swedish data.
Who should act and when
Anyone at average risk should talk with their doctor about starting screening at age 45. People with a family history of colorectal cancer, inflammatory bowel disease, or certain inherited syndromes often need to start earlier and screen more often. Diagnoses are also climbing in adults under 50, and clinicians increasingly urge younger people not to dismiss early warning signs of colorectal cancer such as rectal bleeding, unexplained weight loss or persistent changes in bowel habits.
For readers who dread the prep for a colonoscopy, stool-based tests can be done at home and mailed in. Researchers are also studying whether a blood test could eventually replace some current screening steps, though colonoscopy remains the reference standard when a screening test comes back positive.
The takeaway from more than a decade of Swedish data is straightforward. Screening only protects the people who use it.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.